OsteoChondritis Dissecans Disease (OCD)

No, not obsessive compulsive disorder. Its OsteoChondritis Dissecans Disease.

Osteochondritis dissecans (OCD) is a condition of the joints in which a cartilage, along with a thin layer of bone beneath, becomes loose from the end of the bone. It occurs mostly in young men, usually following an injury to the joint. Knee is the most commonly affected joint, though osteochondritis dissecans may occur in other joints as well.

If the loosened piece of cartilage and bone stay close to the area from where they disjoin, the patient may experience only few or no symptoms of the condition, and the fracture may heal on its own. However, persistent pain may occur if the loosened fragments get caught between the moving parts of the joint, and surgical intervention might become necessary.

What are the causes of the disorder?

The exact cause of osetochondritis dissecans is not known. The most common cause is believed to be a reduction in the blood flow to the end of the affected bone, which may occur due to repetitive trauma (or multiple events of minor unnoticeable injuries) that damage the end of the bone involved.

This usually happens due to overuse, especially in sports that require lot of jumping and rapid changes in direction. A genetic link that makes some people more inclined to develop the disorder is also considered, and is believed to be responsible for about 10 per cent of all cases.

What does one needs to know about symptoms or signs?

Osteochondritis dissecans may not cause any symptoms, or the symptoms may develop either suddenly or gradually, or even come and go. Sometimes, the condition is discovered through a chance x-ray for another reason. Signs and symptoms of osteochondritis dissecans include:

1. Pain - Pain may be triggered by physical activity like walking up stairs, climbing a hill or playing sports.
2. Swelling and tenderness - The skin around the affected joint may appear swollen and tender.
3. Joint locking or popping - The joint may get stuck in one position or may pop if a loose fragment gets caught between bones.
4. Weakness in joint - A feeling of 'joint giving away' could be experienced by the patient.
5. Decreased range of motion - The patient is unable to stretch the affected limb completely.

Which specialist should be consulted in case of signs and symptoms?

People experiencing symptoms that resemble osteochondritis dissecans should consult an orthopaedic surgeon or a specialist in sports medicine.

What are the screening tests and investigations done to confirm or rule out the disorder?

The doctor asks questions related to the patient's medical history and confirms diagnosis through the following tests:

1. X-rays - The doctor may recommend x-rays of both limbs to compare the normal with any abnormality in the other.
2. Magnetic resonance imaging (MRI) - Radio waves and strong magnetic field provide detailed images of both hard and soft tissues. MRI scans help the doctor to determine the course of treatment, either through conservative means or requirement of surgery.
3. Computerised tomography (CT) - X-ray images are taken from different angles to create cross-sectional images of internal structures, as well as cartilage and bone. This allows the doctor to pinpoint the location of loosened fragments within a joint.

What treatment modalities are available for management of the disorder?

Treatment of osteochondritis dissecans aims to restore the normal functioning of the joint and relieve pain, along with reducing any risk of developing osteoarthritis. The different treatment options include:

1. Therapy - Conservative treatment measure include: Resting of the joint - Healing is promoted by providing adequate rest to the affected joint. Activities like running and jumping that put stress on the joint should be avoided. The patient may be given crutches for support, or braces (for knees) to immobilize the affected joint for few weeks.
2. Physical therapy - This includes range of motion exercises and stretching to strengthen the muscles that support the involved joint. Physical therapy is also recommended post surgery.
3. Surgery - In case conservative therapy fails after a period of three to six months, the patient may require surgery to reattach the loosened fragments to the bone. Many surgeries are performed arthroscopically, wherein a thin, tube with a lighted camera and surgical tools are inserted through small incisions around the joint. Depending on the size of the loosened fragment or fractures in the bone, the surgeon may fill the defect with collagen fibres (fibrocartilage). Recent advances allow the use of the patient's own bone marrow in rebuilding the damaged area in the knee, facilitating growth of new tissue to fill the space where bone fragment was removed.

What are the known complications in management of the disorder?

Osteochondritis dissecans can increase the patient's risk of developing osteoarthritis in the affected joint.

How can the disorder be prevented from happening or recurring?

Persons involved in high-intensity sports must educate themselves about the risks associated with overuse of any joint. Learning proper techniques and understanding the mechanics of the sport, along with strength training and stability training exercises helps reduce the chances of injury.  

Do YOU have pain in your joints? Contact us to get expert advice for your treatment!